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de Beaufort C, Gomber A, Sap S, Laffel L. From paediatric to adult diabetes care: lost in transition. Lancet Diabetes Endocrinol 2023; 11:446-448. [PMID: 37209705 PMCID: PMC10851110 DOI: 10.1016/s2213-8587(23)00091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette 4356, Luxembourg.
| | - Apoorva Gomber
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Suzanne Sap
- Department of Paediatrics, Faculty of Medicine, University of Yaounde, Yaounde, Cameroon
| | - Lori Laffel
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Abdel Magid HS, Milliren CE, Rice K, Molanphy N, Ruiz K, Gooding HC, Richmond TK, Odden MC, Nagata JM. Adolescent individual, school, and neighborhood influences on young adult hypertension risk. PLoS One 2022; 17:e0266729. [PMID: 35482649 PMCID: PMC9049504 DOI: 10.1371/journal.pone.0266729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure. METHODS Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects. RESULTS The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3). CONCLUSION We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.
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Affiliation(s)
- Hoda S. Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America
- Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America
| | - Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Kathryn Rice
- Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America
| | - Nina Molanphy
- Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America
| | - Kennedy Ruiz
- Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America
| | - Holly C. Gooding
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - Tracy K. Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michelle C. Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America
| | - Jason M. Nagata
- Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, California, United States of America
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